Cross-vendor evaluation of key user-defined clinical decision support capabilities: a scenario-based assessment of certified electronic health records with guidelines for future development.
Cross-vendor evaluation of key user-defined clinical decision support capabilities: a scenario-based assessment of certified electronic health records with guidelines for future development.
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对关键的用户定义的临床决策支持功能进行跨供应商评估：对经过认证的电子健康记录进行基于场景的评估，并提供未来开发指南。
DOI：
10.1093/jamia/ocv073
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Sittig,DeanF
中科院分区：
文献类型：
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作者：
McCoy,AllisonB;Wright,Adam;Sittig,DeanF
临床决策支持（CDS）对于提供高质量，具有成本效益和安全的医疗保健至关重要。作者试图评估CDS的能力，在电子健康记录（EHR）systems.MethodsWe评估了CDS的实施能力的8个办公室的国家协调员的卫生信息技术授权认证机构（ONC-ACB）认证的EHR。在每个EHR中，作者试图实现3个用户定义的规则，这些规则利用了典型EHR预期的各种数据和逻辑元素，并代表了临床上重要的循证护理。规则是：1）如果患者在他或她的活性药物列表中有胺碘酮，并且在过去12个月内没有记录促甲状腺激素（TSH）结果，建议订购TSH; 2）如果患者的血红蛋白A1 c结果>7%，并且在他或她的问题列表中没有糖尿病，建议将糖尿病添加到问题列表中; 3）如果患者的问题清单上有冠状动脉疾病，而有效药物清单上没有阿司匹林，建议订购阿司匹林。5个EHR能够执行所有3项规则，其余3个EHR无法执行任何规则。其中一个根本不允许用户自定义CDS规则。最常见的缺点包括无法使用实验室测试结果的规则，限制规则的时间，使用先进的布尔逻辑，从警报界面执行操作，并充分测试rules. ConclusionEHR认证和实施程序的显着改进是必要的。
ObjectiveClinical decision support (CDS) is essential for delivery of high-quality, cost-effective, and safe healthcare. The authors sought to evaluate the CDS capabilities across electronic health record (EHR) systems.MethodsWe evaluated the CDS implementation capabilities of 8 Office of the National Coordinator for Health Information Technology Authorized Certification Body (ONC-ACB)-certified EHRs. Within each EHR, the authors attempted to implement 3 user-defined rules that utilized the various data and logic elements expected of typical EHRs and that represented clinically important evidenced-based care. The rules were: 1) if a patient has amiodarone on his or her active medication list and does not have a thyroid-stimulating hormone (TSH) result recorded in the last 12 months, suggest ordering a TSH; 2) if a patient has a hemoglobin A1c result >7% and does not have diabetes on his or her problem list, suggest adding diabetes to the problem list; and 3) if a patient has coronary artery disease on his or her problem list and does not have aspirin on the active medication list, suggest ordering aspirin.ResultsMost evaluated EHRs lacked some CDS capabilities; 5 EHRs were able to implement all 3 rules, and the remaining 3 EHRs were unable to implement any of the rules. One of these did not allow users to customize CDS rules at all. The most frequently found shortcomings included the inability to use laboratory test results in rules, limit rules by time, use advanced Boolean logic, perform actions from the alert interface, and adequately test rules.ConclusionSignificant improvements in the EHR certification and implementation procedures are necessary.